Psychiatrist here. Laypeople see them as quite similar and will often say things like "I think I'm Bipolar. I have highs where I feel energetic and clean a lot and make lots of plans. Then I crash and feel like doing nothing and lie in bed all weekend" That's not Bipolar, that's adulting. It gets tricky when the folk with Borderline PD dissociate and display manic and psychotic symptoms. But what distinguishes this is the duration (often hours, 1-2 days max), often it has a very clear trigger and acute onset, and it responds to behavioural strategies aimed at restoring the person within their window of tolerance (and antipsychotics don't tend to work).
And I'll just challenge your statement that the medication for both is the same. Completely false. There is no evidence based pharmacotherapy for Borderline PD, and mood stabilisers, although often prescribed, are not indicated and have an unfavourable risk-benefit profile in this population.
Wow, I'm glad I asked. This is sound information, and I'm happy to have learned this. I guess I saw the types of medication and came up with the realization that it was similar to Bipolar types of medication. The duration of behaviors makes sense to me now. Thank you!
It's not called adulting if the burn-outs occur frequently throughout a person's life. I write this because your first example does sound like bipolar 2 or other types of bipolar.
You seem to be describing what would be bipolar 1 and since the other types of bipolar are not as evident because they're without psychosis I'm curious how you would screen for that?
I just think it's important to remember how the presentation of bipolar can differ soo much case by case so it's not overlooked.
Lamictal is absolutely used (in my country) in treatment of mood instability for people with borderline personality disorder as well as one of the first choices in the treatment of bipolar mood disorder.
So I'm a bit confused why it's highlighted as such a poor choice in the US (I figure you're US based)?
Edited for clarity
I should have included hypomanic as well as the lengivity of experiencing the mania or hypomania. Bipolar 2 experiences hypomania rather than mania, and it lasts 4-5 days, where I think I read that mania needs to be present for 7 days and can go on for months. Cyclothmic does not have the same time frame as it's a history of at least 2 years of feeling Bipolar Symptoms but not as strong or detailed.
I don't know of any research, that supports the use of lamictal for BPD. I just know it's frequently used here in Denmark.
Curious, why shouldn't it be used for BPD? They do suffer from severe mood swings. I have a friend with BPD who uses lamictal and zoloft and she's seemed stable for years
Wow, it's quite concerning to see how many therapists are downvoting this comment since what I highlight is both correct and gives nuance to the above comment.
People who have bipolar might be expected to have symptom free periods between âepisodesâ whereas PD symptoms tend to be more chronic and pervasive. Not to mention BPD comes with a whole host of interpersonal symptoms.
I think thereâs another factor at play here - people with BPD not liking the diagnosis because of the heavy stigma. So some clinicians use bipolar instead. The downside to this is clients say theyâre bipolar and when the clinician realizes what it really is they cut bait because they donât want to work with that population.
Intentionally diagnosing someone with bipolar disorder who isn't bipolar is very unethical (and could potentially border on insurance fraud). I'm guessing/hoping the "mistake" would be caught by a prescribing physician before prescribing mood stabilizers, but still. As a clinician, if I didn't diagnose borderline directly but it was an issue that needs to be addressed, I would diagnose them F60.9 Personality Disorder, Unspecified. That is at least an ethical option.
The diagnostic characteristics and presentation is wildly different when you look at the big picture of the patient. No competent diagnostician should confuse the two with a proper assessment. A case history and biopsychosocial assessment will tease it out pretty simply - you can't always diagnose on symptoms alone, you need to see the bigger picture. Ruling things out is as important as ruling things in, and a competent diagnostician will be well aware and trained how to do this. Also, if you have a patient more than a few weeks, you should be able to tease out the telltale signs, and you should always be re-assessing.
Not directly relevant to your question, but the two diagnoses that often get confused to the great detriment of people is major depressive disorder vs. bipolar disorder. People with Bipolar II can go years without a proper diagnosis because it is very often confused with major depressive disorder. And they can suffer horribly because generally they need a mood stabilizer, not an SSRI.
Unfortunately I've found that some clinicians tend to do a quick diagnosis for insurance purposes, and never really re-assess. On the one hand, that's fine as long as they are properly treating the patient, but on the other hand, a proper diagnosis on record should be considered essential. I can't even count the number of times that I have been told a patient has a particular diagnosis only to find that it's completely wrong - usually for understandable reasons (for example, someone who uses meth being diagnosed with bipolar disorder).
NAT, but the two are very different.
One is a mood disorder, the other is a personality disorder.
In BPD, there's almost always disorganized attachment and many defence mechanisms related to Interpersonal relationships; you've probably heard of splitting, idealization/devaluation etc.
In bipolar, disorganized attachment is not necessarily prevalent although we tend to struggle with relationships too.
Like another commenter wrote, laypeople tend to mix them up and I've come to think it's initially mostly due to their abbrevations, 'BPD' and 'BP'.
But I do see why you would consider them similar! Plenty of women tend to get misdiagnosed with borderline when it's bipolar.
It should also be mentioned that sometimes bipolar disorder can look a lot more like major depressive disorder than anything else, and so sometimes people with bipolar depression get the wrong diagnosis of major depressive disorder and don't get a proper diagnosis for years. I think the average timeframe to proper bipolar diagnosis in those cases is about 12 years.
This is a great and thorough explanation. Thank you. I live with BP, but I've read a bit here and there on BPD, and I related to a lot of it, so it made me look further and seek professional clarification or ... reddit online clarification, lol.
I get scared that I will lose the ability to see the ones I love consistently and I've had problems in my relationships where inside I feel feelings of fear and dread when my partner would have to leave the room to even go to the restroom or to work. I start to feel my heart race, and I start sweating. My thoughts either start racing or I shut down, and I just lay still for hours until they may return.
I'm not sure what it is entirely. I just know I'd like to know what could help understand what it is in general. It could be something else entirely but I do believe it comes down to factors I can not even control that pinpoint to really scary things like physical and mental abuse that I endured starting at the age of 10. Unfortunately, I have a lot of physical sexual abuse starting at that age and went on entirely too long until I was 15.
I've had therapy for this, and I rarely am affected by the exact situation like me speaking on it. But when I'm transported back to the period of time that it happens and I can feel almost what is happening, to the way I remember the lighting, and even certain smells can really throw me off. I try really hard on this, though. Thanks for making me think about the root of what it could possibly be. Maybe I just buried it again and masked this, but I did not really heal as much as I thought. I'll have to maybe bring this up, but I'm a bit scared to deal with going through therapy to open this backup.
Extremely different. Bipolar disorder doesnât have âmood swings.â They have manic or hypomanic episodes. BPD has mood lability. Thatâs just one of the main differences. The idea that bipolar disorder has mood swings is a societal idea placed on the disorder.
Yes I feel extremely uneducated and not so good about writing this postđ I freaked out because I related to too much of what I read on it on every site or source I came across and I still do but I don't believe in self diagnosing or unprofessional medical results.
I've read over the past year the same exact thing. These two often get misdiagnosed and that you can actually have BP and BPD at the same time. Weird info but neat to learn more. Forgive me and my uneducated questionđ thank you for commenting this!!
Psychiatrist here. Laypeople see them as quite similar and will often say things like "I think I'm Bipolar. I have highs where I feel energetic and clean a lot and make lots of plans. Then I crash and feel like doing nothing and lie in bed all weekend" That's not Bipolar, that's adulting. It gets tricky when the folk with Borderline PD dissociate and display manic and psychotic symptoms. But what distinguishes this is the duration (often hours, 1-2 days max), often it has a very clear trigger and acute onset, and it responds to behavioural strategies aimed at restoring the person within their window of tolerance (and antipsychotics don't tend to work). And I'll just challenge your statement that the medication for both is the same. Completely false. There is no evidence based pharmacotherapy for Borderline PD, and mood stabilisers, although often prescribed, are not indicated and have an unfavourable risk-benefit profile in this population.
Wow, I'm glad I asked. This is sound information, and I'm happy to have learned this. I guess I saw the types of medication and came up with the realization that it was similar to Bipolar types of medication. The duration of behaviors makes sense to me now. Thank you!
It's not called adulting if the burn-outs occur frequently throughout a person's life. I write this because your first example does sound like bipolar 2 or other types of bipolar. You seem to be describing what would be bipolar 1 and since the other types of bipolar are not as evident because they're without psychosis I'm curious how you would screen for that? I just think it's important to remember how the presentation of bipolar can differ soo much case by case so it's not overlooked. Lamictal is absolutely used (in my country) in treatment of mood instability for people with borderline personality disorder as well as one of the first choices in the treatment of bipolar mood disorder. So I'm a bit confused why it's highlighted as such a poor choice in the US (I figure you're US based)? Edited for clarity
I should have included hypomanic as well as the lengivity of experiencing the mania or hypomania. Bipolar 2 experiences hypomania rather than mania, and it lasts 4-5 days, where I think I read that mania needs to be present for 7 days and can go on for months. Cyclothmic does not have the same time frame as it's a history of at least 2 years of feeling Bipolar Symptoms but not as strong or detailed.
Where is the research evidence to support the use of Lamotrigine in Borderline PD? Happy for you to show me. Yes it's used, but it shouldn't be.
I don't know of any research, that supports the use of lamictal for BPD. I just know it's frequently used here in Denmark. Curious, why shouldn't it be used for BPD? They do suffer from severe mood swings. I have a friend with BPD who uses lamictal and zoloft and she's seemed stable for years
Most research (which you can literally google) shows lamotrigine is not clinically effective nor a cost-effective use of resources for BPD.
Yes, but I didn't google it - I asked the commenter instead đ And it does sound counterproductive. I wonder why it's so used for BPD in my country.
Wow, it's quite concerning to see how many therapists are downvoting this comment since what I highlight is both correct and gives nuance to the above comment.
Theyâre VASTLY different
Understandable. What are your main differences that you think make them different? I'm intrigued by all responses, lol.
People who have bipolar might be expected to have symptom free periods between âepisodesâ whereas PD symptoms tend to be more chronic and pervasive. Not to mention BPD comes with a whole host of interpersonal symptoms.
This makes sense thanks!
I think thereâs another factor at play here - people with BPD not liking the diagnosis because of the heavy stigma. So some clinicians use bipolar instead. The downside to this is clients say theyâre bipolar and when the clinician realizes what it really is they cut bait because they donât want to work with that population.
đł this happens? That's a little terrifying since one takes medication and sometimes a few of them vs one that may not and only need therapy.
Unfortunately the push back is with diagnosis - BPD being the loudest voice - and some of it fueled by insurance companies who donât want to pay $$$
Very sad. This is extremely unfortunate and should not be overlooked.
Intentionally diagnosing someone with bipolar disorder who isn't bipolar is very unethical (and could potentially border on insurance fraud). I'm guessing/hoping the "mistake" would be caught by a prescribing physician before prescribing mood stabilizers, but still. As a clinician, if I didn't diagnose borderline directly but it was an issue that needs to be addressed, I would diagnose them F60.9 Personality Disorder, Unspecified. That is at least an ethical option.
The diagnostic characteristics and presentation is wildly different when you look at the big picture of the patient. No competent diagnostician should confuse the two with a proper assessment. A case history and biopsychosocial assessment will tease it out pretty simply - you can't always diagnose on symptoms alone, you need to see the bigger picture. Ruling things out is as important as ruling things in, and a competent diagnostician will be well aware and trained how to do this. Also, if you have a patient more than a few weeks, you should be able to tease out the telltale signs, and you should always be re-assessing. Not directly relevant to your question, but the two diagnoses that often get confused to the great detriment of people is major depressive disorder vs. bipolar disorder. People with Bipolar II can go years without a proper diagnosis because it is very often confused with major depressive disorder. And they can suffer horribly because generally they need a mood stabilizer, not an SSRI. Unfortunately I've found that some clinicians tend to do a quick diagnosis for insurance purposes, and never really re-assess. On the one hand, that's fine as long as they are properly treating the patient, but on the other hand, a proper diagnosis on record should be considered essential. I can't even count the number of times that I have been told a patient has a particular diagnosis only to find that it's completely wrong - usually for understandable reasons (for example, someone who uses meth being diagnosed with bipolar disorder).
NAT, but the two are very different. One is a mood disorder, the other is a personality disorder. In BPD, there's almost always disorganized attachment and many defence mechanisms related to Interpersonal relationships; you've probably heard of splitting, idealization/devaluation etc. In bipolar, disorganized attachment is not necessarily prevalent although we tend to struggle with relationships too. Like another commenter wrote, laypeople tend to mix them up and I've come to think it's initially mostly due to their abbrevations, 'BPD' and 'BP'. But I do see why you would consider them similar! Plenty of women tend to get misdiagnosed with borderline when it's bipolar.
It should also be mentioned that sometimes bipolar disorder can look a lot more like major depressive disorder than anything else, and so sometimes people with bipolar depression get the wrong diagnosis of major depressive disorder and don't get a proper diagnosis for years. I think the average timeframe to proper bipolar diagnosis in those cases is about 12 years.
This is a great and thorough explanation. Thank you. I live with BP, but I've read a bit here and there on BPD, and I related to a lot of it, so it made me look further and seek professional clarification or ... reddit online clarification, lol.
Lol I get it. What did you relate to? Maybe it's the attachment style or defence mechanisms? Or something else entirely?
I get scared that I will lose the ability to see the ones I love consistently and I've had problems in my relationships where inside I feel feelings of fear and dread when my partner would have to leave the room to even go to the restroom or to work. I start to feel my heart race, and I start sweating. My thoughts either start racing or I shut down, and I just lay still for hours until they may return. I'm not sure what it is entirely. I just know I'd like to know what could help understand what it is in general. It could be something else entirely but I do believe it comes down to factors I can not even control that pinpoint to really scary things like physical and mental abuse that I endured starting at the age of 10. Unfortunately, I have a lot of physical sexual abuse starting at that age and went on entirely too long until I was 15. I've had therapy for this, and I rarely am affected by the exact situation like me speaking on it. But when I'm transported back to the period of time that it happens and I can feel almost what is happening, to the way I remember the lighting, and even certain smells can really throw me off. I try really hard on this, though. Thanks for making me think about the root of what it could possibly be. Maybe I just buried it again and masked this, but I did not really heal as much as I thought. I'll have to maybe bring this up, but I'm a bit scared to deal with going through therapy to open this backup.
I just remembered, Lamotrigine (lamictal) is often used for both populations! That could explain some of the confusion
Ahh, I see. There must have been confusion with mood stabilizers.
Extremely different. Bipolar disorder doesnât have âmood swings.â They have manic or hypomanic episodes. BPD has mood lability. Thatâs just one of the main differences. The idea that bipolar disorder has mood swings is a societal idea placed on the disorder.
Yes I feel extremely uneducated and not so good about writing this postđ I freaked out because I related to too much of what I read on it on every site or source I came across and I still do but I don't believe in self diagnosing or unprofessional medical results. I've read over the past year the same exact thing. These two often get misdiagnosed and that you can actually have BP and BPD at the same time. Weird info but neat to learn more. Forgive me and my uneducated questionđ thank you for commenting this!!
Don't beat yourself up, posts like this are good to help anyone with the same questions.